After two years of torture, horrifying living conditions, continuous starvation, infections, and darkness, 20 people taken captive by the Hamas terrorist group on October 7, 2023, saw the light of day on Monday for the first time since their capture.
Despite these monstrous conditions, they appeared relatively well, standing on their feet and smiling. Part of this is due to the reality of their lives changing, and much of it is pushed forward by striking hormonal changes in the body.
Hundreds of days of fear, starvation, and loneliness were replaced, in an instant, by a feeling of freedom, lightness, and witnessing the light of day. The body, for its part, has its own reaction to moving swiftly from a place of intense stress: neurotransmitters and hormones awaken and heighten specific senses.
All at once, adrenaline, dopamine, and serotonin are released, granting the body a sense of intense happiness and force of life.
Adrenaline is released almost instantly when the brain senses stress or danger through activation of the sympathetic nervous system and the adrenal medulla. It raises the heart rate, sharpens the senses, and directs blood flow to the muscles.
The spike in adrenaline for people like the hostages, who have been in intense “survival mode” for such a long time, makes them look awake, strong, and full of energy – even though the body is exhausted.
Dopamine, the brain’s “motivation and reward” messenger, helps people move, learn, and feel pleasure when something good happens. For the hostages, simply meeting their loved ones, feeling the sun, and eating warm food is likely to trigger a high wave of dopamine release. This also makes them appear happy and strong.
However, when dopamine levels drop back to normal, it can leave people with a sense of emptiness, sadness, and – in the case of the hostages – post-traumatic depression.
Serotonin, the body’s “mood stabilizer,” which helps one feel calm, content, and balanced while regulating sleep, appetite, and digestion, usually joins these two neurotransmitters and hormones in such situations.
Since the hostages lacked serotonin during captivity due to intense and prolonged fear and torture, the sudden rise in it is likely to lead to a sense of calm and self-confidence – the body’s attempt to regulate the overwhelming influx of sensations. This newfound balance, however, is fragile.
Joining this cocktail is cortisol, the body’s main stress hormone, which helps maintain alertness, energy, and stability under pressure, though too much or too little may cause serious health problems.
In the case of the hostages, cortisol plays a double role: while in captivity, its levels were intensely and continuously high, while upon return, it is likely to drop, which could lead to intense tiredness, headaches, low blood pressure, and a higher risk of worsening infections.
Overall, the body transitions quickly from a state of survival to a state of recovery. Its neurotransmitters and hormones rush to achieve restoration.
Long-term consequences
THE HOSTAGES are most likely suffering the long-term consequences of two years of captivity: extreme starvation leads to loss of muscle and fat, depletion of essential lipids, and the use of whatever muscle remains as a source of energy.
This process usually leads to general weakness and a state of catabolism, the set of metabolic processes in the body that break down large molecules – like proteins, fats, and carbohydrates – into smaller ones, releasing energy that the body can use. Essentially, the body is taking complex substances and “dismantling” them to produce energy or raw materials.
Additionally, the hostages’ immune systems have weakened significantly, their mineral banks depleted. This could mean they are at risk of heart rhythm disorders and loss of consciousness.
Another result of the conditions of captivity is continued deprivation of B vitamins, which are crucial for turning food into energy, keeping the brain and nerves healthy, supporting blood and heart health, and regulating mood.
Deficiency can affect both the body and mind, leading to fatigue, confusion, depression, or nerve problems. Even the heightened and sudden activity of the “happy” hormones cannot quickly heal the damage already sustained by the brain.
On the psychological plane, the damage is much deeper than meets the eye. Many hostages are expected to suffer from post-traumatic stress disorder (PTSD), characterized by flashbacks, anxiety, avoidance of confined spaces, and a sense of detachment from reality.
The nervous system, having been in a “state of emergency” for such a prolonged time, will face a challenging transition back to normalcy.
In their first few days of freedom, the hostages will need – and are set to have – a full support system of doctors, psychologists, and dietitians. Their nutritional journey must be slow and steady to avoid what is known as “refeeding syndrome,” a potentially serious medical condition that can occur when a severely malnourished person begins to eat or receive nutrition again too quickly.
Psychological healing will require careful steps as well. The collapse that can be experienced after the initial euphoria of freedom is quite common. When the body stops releasing stress hormones, what takes place instead is a “chemical quiet,” which can leave the body emotionally drained.
Many freed hostages testified to these drastic changes in their bodies, minds, and souls once they returned to the free world. Many also spoke of the survivor’s guilt they felt, knowing their brothers and sisters remained in captivity.
All of the live hostages are out, although only four of the slain ones were transferred to Israeli authorities throughout Monday. Once all of the kidnapped children are home, a true – individual and national – healing process may commence.